Table 2.
Economic Evaluations of Specialist Inpatient Palliative Care Consultation Teams
| Ref # | Study | Hospital(s) ------------Team label | Design | Sample size Intervention/control | Principal diagnosisa | Outcomes of interest | Key findings |
|---|---|---|---|---|---|---|---|
| (23) | Cowan, 2004 | Hospital not categorized by authors ------------ Advanced Illness Assistance Team (AIA) |
Cohort | 164 PC patients 152 UC patients |
Cancer 27% Neurologic 18% Pulmonary 17% Cardiovasc. 12% Organ failure 7% Gastrointestinal 7% Chronic pain 6% Infection 4% Other 2% |
Hospital charges; LOS | Lower (∼7%) mean daily charges for PC than UC (p=0.006) For patients with LOS>7 days, PC reduces LOS |
| (24) | Penrod et al., 2006 | Two Veterans Administration (VA) facilities ------------ Palliative Care Consultation Team (PCCT) |
Cohort | 82 PC patients 232 UC patients |
Cancer 50% Infectious disease 10% Cardiovascular 7% Pulmonary 10% Gastrointestinal 7% Genitourinary 4% Other 12% |
Hospital costs; ICU | PC patients 42% less likely to be admitted to ICU Lower (∼22%) daily direct costs for PC than UC (p<0.0001) Laboratory & radiology also lower; no difference for pharmacy |
| (25) | Ciemins et al., 2007 | Large, private, not-for-profit medical center ------------ Palliative Care Consultation Service (PCCS) |
Cohort | 27 PC patients 128 UC patients |
Cancer 100% | Hospital costs | Lower (∼13%b) mean daily costs for PC than UC (p<0.01) Lower (∼16%) mean total costs for PC than UC (p<0.0001) |
| (26) | Bendaly et al., 2008 | Public hospital ------------ Palliative Care consultation (PCc) |
Cohort | 61 PC patients 55 UC patients |
Pulmonary disorders and/or MV 30% Cardiovascular disorders 23% Neoplasms 16% Infections with or without sepsis 15% Other 16% |
Hospital charges; LOS | Lower (∼16%) median total charges for PC than UC (p<0.001) No significant diference in LOS (p=0.57) |
| (27) | Gade et al., 2008 | Three managed care organization hospitals ------------ Interdisciplinary Palliative Care Service (IPCS) |
RCT | 275 PC patients 237 UC patients |
Cancer 27% CHF 9% MI 1% Other heart disease 3% COPD 13% Other pulmonary disease 1% ESRD 4% Organ failure 12% Stroke 9% Dementia 3%c |
Total health service costs 6 months postdischarge; symptom control, emotion/ spiritual support, satisfaction | Lower (∼32%) total mean health costs for PC than UC (p<0.001) Lower (∼23%) total mean health costs for PC than UC once IPCS staffing accounted for No difference in physical, emotional symptoms Improved satisfaction |
| (28) | Hanson et al., 2008 | Tertiary academic medical center ------------ Palliative Care Consultation Service (PCCS) |
Cohort | 104 PC patients 1,813 UC patients |
Cancer 61% Cardiopulmonary diseases 11% Neurologic diseases 5% Hepatic/renal failure 4% Acute infections 14%d |
Hospital costs, LOS | No difference in total variable costs (p=0.78) Lower (∼10%) daily variable costs for PC than UC (p=0.03) Larger proportional cost savings per day for PC where LOS is greater |
| (29) | Morrison et al., 2008 | Five community hospitals & three academic medical centers ------------ Palliative Care Consultation Team (PCCT) |
Cohort |
Live discharges 2630 PC patients 18,427 UC patients Hospital deaths 2278 PC patients 2124 UC patients |
Live discharge Cancer 29% Infection 4% Cardiovascular 19% Pulmonary 15% Gastrointestinal 7% Genitourinary 4% Other 22% Hospital death Cancer 19% Infection 11% Cardiovascular 24% Pulmonary 18% Gastrointestinal 9% Genitourinary 4% Other 14% |
Hospital costs |
Live discharges Lower total costs (∼14%; p=0.02), total costs per day (∼19%; p<0.001), total direct costs (∼15%; p=0.004), direct costs per day (∼21%; p<0.001) for PC than UC Hospital deaths Lower total costs (∼18%; p=0.001), total costs per day (∼22%; p<0.001), total direct costs (∼22%; p=0.003), direct costs per day (∼25%; p<0.001) for PC than UC |
| (30) | Penrod et al., 2010 | Five Veterans Administration (VA) facilities ------------ Palliative Care Consultation Team (PCCT) |
Cohort | 606 PC patients 2715 UC patients |
Cancer 62%e COPD 36% CHF 28% HIV/AIDS 3% |
Hospital costs, ICU use | PC patients 44% less likely to be admitted to ICU Lowerf daily direct costs for PC than UC (p<0.0001) Pharmacy, laboratory, & nursing also lower; no difference for radiology |
| (31) | Morrison et al., 2011 | A community hospital, two academic medical centers, and a safety-net hospital ------------ Palliative Care Consultation Team (PCCT) |
Cohort |
Live discharges 290 PC patients 1427 UC patients Hospital deaths 185 PC patients 149 UC patients |
Cancer 58% AIDS 2% CHF 12% COPD 2% Advanced liver disease 19% Prolonged ICU stay 6.9% |
Hospital costs, ICU use, LOS |
Live discharges Lower total costs (∼11%; p<0.05), total costs per day (∼18%; p<0.001) for PC than UC Lower laboratory (∼16%) & imaging (∼13%) costs though not statistically significant Slightly higher ICU LOS but significantly lower (∼42%; p<0.001) ICU cost per admission for PC than UC Hospital deaths Lower total costs (∼11%; p<0.05), total costs per day (∼9%; p<0.01) for PC than UC Lower pharmacy (∼21%; p<0.001) for PC than UC ; no difference for laboratory or imaging Lower ICU LOS (10.2 days against 13.8; p<0.01) for PC than UC; no significant cost difference |
| (33) | Whitford et al., 2013 | Integrated medical center comprising two hospitals ------------ Palliative Care Consult Service (PCCS) |
Cohort |
Live discharges 1177 PC patients 3531 UC patients Hospital deaths 300 PC patients 900 UC patients |
Live discharge Infectious 8% Neoplasm 21% Endocrine 2% Nervous 3% Circulatory 30% Respiratory 16% Digestive 8% Musculoskeletal 9% Other 3% Hospital death Infectious 4% Neoplasm 32% Endocrine 3% Nervous 4% Circulatory 23% Respiratory 10% Digestive 7% Musculoskeletal 3% Other 14% |
Hospital costs, incorporating ICU costs |
Live discharges Lower total costs (∼5%; p<0.05) for PC than UC Lower procedure costs; higher evaluation, imaging, pharmacy costs for PC than UC (no % or p value given) Hospital deaths Lower total costs (∼31%; p<0.05) for PC than UC Lower procedure, evaluation, imaging, laboratory, pharmacy costs for PC than UC (no % or p value given) |
a
For PC group at time of consultation.
b
There is inconsistency in reporting of cost difference as a percentage. Ciemins et al. use the cost of palliative care as the base cost in calculations, i.e., [%ΔC=((CPC – CUC)/CPC) x 100] while others (e.g., Hanson et al.) use the cost of usual care, i.e., [%ΔC=((CPC – CUC)/CUC)×100]. In this table and throughout the text all %ΔC have been calculated using the latter method.
c
Gade et al. report a diagnosis for 196 PC patients (=71.3%)
d
Primary diagnoses for all PC patients in overall sample (n=304); authors do not report corresponding figures for sub-sample in economic analysis (n=104).
e
Patients could have more than one advanced disease diagnosis; therefore does not add up to 100%.
f
No UC cost given so not possible to calculate proportional saving.
PC, palliative care; UC, usual care; LOS, length of stay; ICU, intensive care unit; RCT, randomized controlled trial; MV, mechanical ventilation; CHF, congestive heart failure; MI, myocardial infarction; COPD, chronic obstructive pulmonary disese; ESRD, end-stage renal disease; HIV/AIDS, human immunodeficiency virus/acquired immune deficiency syndrome.